Author: Li LongThe most reasonable way to treat most of the well differentiated thyroid cancer and its metastasis is: "three in one" treatme
Author: Li Long
The most reasonable way to treat most of the well differentiated thyroid cancer and its metastasis is: "three in one" treatment of total thyroidectomy with +131 iodine and thyroid hormone.
Why is "three in one" treatment is the most reasonable way?
There is no doubt that, like most malignant tumors, thyroid cancer should be the first choice of surgical treatment. However, for a long time, because of the high recurrence rate (median 35%), the extent of thyroidectomy for differentiated thyroid cancer has been the focus of surgical controversy. Due to different views, the actual operation is very different. There were two kinds of subtotal thyroidectomy and total thyroidectomy, but there were at least 4 different methods for subtotal resection:
Unilateral lobectomy of the glandular lobe;
The side lobe and isthmus resection;
The side lobe and isthmus + contralateral lobe resection;
The side lobe and isthmus + contralateral lobe subtotal.
Therefore, it is difficult to determine the best solution for complex lesions, the specific implementation is also very difficult, a trick will have a significant impact on clinical treatment.
With the development of modern medicine, the research on thyroid cancer is also deepening, people's understanding of the disease has been greatly improved. In 1988 WHO proposed thyroid microcarcinoma (thyroid micro-carcinoma TMC) definition: where the maximum tumor diameter less than 1cm of the thyroid carcinoma, with or without regional lymph node or distant lymph node metastasis is called TMC. TMC is well differentiated papillary carcinoma. Reported that the autopsy specimens of thyroid papillary thyroid microcarcinoma incidence rate was 5.6%, accounting for the same period of thyroid surgery 4.2%, accounting for 47.9% of the differentiated thyroid carcinoma, thyroid clinically non palpable. The prevalence rate was 3%. Because of the characteristics of TMC, such as small diameter, few symptoms and slow clinical progress, it is difficult to be detected early. A more cellular grade of metastatic lesions are not accessible to the naked eye (the report shows that the contralateral thyroid gland metastasis of differentiated thyroid cancer is 38%~87%), so it is difficult to diagnose. It is speculated that TMC may be the main reason for the high recurrence rate of this disease.
Since the early diagnosis of TMC and the presence of TMC in the naked eye is difficult to determine, clinical studies have focused on the exploration of new therapeutic approaches. It has been proved that 131I can effectively eliminate the residual thyroid tissue and cell level TMC after thyroid cancer surgery. It is reported that the recurrence rate of thyroid cancer after surgical resection is 35%, such as postoperative with radionuclide therapy, and then a larger dose of thyroid hormone replacement therapy, the recurrence rate can be reduced to 1%~2.5%. Another report, a simple operation for cancer, the recurrence rate of up to 32%; surgery + oral thyroid hormone, the recurrence rate was 11%; surgery +131I + oral thyroid hormone treatment, the recurrence rate was only about 2.7%. Foreign reports, after surgery with 131I treatment, the mortality rate of patients with simple surgery decreased by 3.8 ~ 5.2 times, the recurrence rate was reduced by 4 times. We call this the "three in one" treatment for thyroid cancer. At present, many scholars at home and abroad in the treatment of differentiated thyroid cancer and follow up to develop a more comprehensive program, the clinical implementation of thyroid cancer, "three in one" treatment plan for the detailed flow chart:
Thyroid cancer, "three in one" treatment program has been recognized by more and more people in the industry, but not the students who have different views on the scope of different lesions. The majority of physicians claim that close to the whole gland resection, as much as possible to remove more thyroid, but must be to protect the parathyroid gland and recurrent laryngeal nerve as guidelines. In fact, the complication of total thyroidectomy is high, and it is not necessary, because it can effectively remove the residual functional thyroid tissue. Another consideration of near total resection is that it is more effective to remove the residual thyroid gland with 131I after a small amount of residual thyroid gland, and the dosage of 131I is also small. In addition, nearly all gland resection caused by hypothyroidism and TSH increased, more sensitive determination of early functional metastases.
The traditional approach recognizes the significance of thyroid hormone therapy
Maintain the normal function of thyroid gland;
To inhibit the secretion of thyroid stimulating hormone, because thyroid stimulating hormone may cause tumor recurrence. Whether it is the thyroid total resection, or partial resection, both the application of thyroid hormone replacement therapy; may be due to lack of understanding of the significance of 131I to remove residual thyroid tissue, and rarely treated with 131I after operation. Because thyroid hormone can not completely inhibit the possible existence of TMC and the metastasis of the lens, the recurrence rate is high after a long time.
It has been recognized that the principle of operation is to remove the cancer tissue as far as possible and to remove the neck lymph nodes that may have occurred. In order not to damage the parathyroid and laryngeal nerve, surgery is difficult to completely resected thyroid (microscope showed that residual thyroid cancer cells, therefore, in the present) after surgical removal of the thyroid, in a timely manner to use 131I to remove residual thyroid tissue, then given thyroid hormone replacement therapy, to reduce the recurrence rate.
Subtotal of at least 4 kinds of schemes: unilateral lobe resection; the side lobe and isthmus resection; the side lobe and isthmus + contralateral lobe resection; the side lobe and isthmus + contralateral lobe subtotal. No matter which kind of, leaving the thyroid tissue in the transfer of cancer cells, the naked eye can not see!
At present the clinical surgery on thyroid cancer are mostly used in the scheme of the. The thyroid hormone produced by the thyroid tissue is simply not able to meet the metabolic needs of the body! From a physiological point of view, has no meaning! Left a potential risk of recurrence! Therefore, the complete removal of the thyroid gland is the best treatment!